JOB DESCRIPTION Job Summary

Leads and directs team responsible for provider data management (PDM) activities including analyzing business processes related to PDM, identifying areas for improvement, and developing and implementing solutions to optimize performance.  Ensures accurate and timely maintenance of critical provider information for all claims/provider databases, and application of business rules as it pertains to contracting, network management and credentialing.

 

Essential Job Duties

• Strategically plans, leads, and manages the provider data management (PDM) function and processes.
• Directs the development, implementation and maintenance of provider data in the claims payment system.
• Supports critical business strategies by providing systematic solutions and recommendations on business processes.
• Responds to legislative and regulatory developments and audits as it relates to provider information; collaborates cross-functionally to face out with regulators to develop and implement appropriate corrective action plans (CAPs) for submission of provider network files, etc. 
• Engages with information technology (IT) and other departments to implement changes to business processes and systems.
 

Required Qualifications

• At least 8 years of experience in provider data management (PDM), including business analytics experience in health care, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Advanced proficiency in data analysis tools and techniques.
• Strong presentation and interpersonal skills, and ability to interact effectively with stakeholders at all levels.
• Strong critical-thinking skills, and attention to detail.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including advanced Excel) and applicable software program(s) proficiency.
 

Preferred Qualifications

 

 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V